![]() ![]() Dexmedetomidine has also been used in peripheral nerve blocks to prolong the duration of analgesia. Because of enthusiasm over apparent prevention/treatment of delirium with dexmedetomidine when used for ICU sedation, it was hoped this benefit would be reproduced for postoperative delirium when using an intraoperative infusion of dexmedetomidine however, a recent randomized trial did not show a statistically significant benefit in this postoperative population. There is evidence for the prevention of emergence agitation in both children and adults. There has been some interest in using dexmedetomidine as an adjunct to prevent emergence agitation, postoperative delirium, and postoperative cognitive dysfunction. However, at least one recent study has been called into question this opioid-sparing effect for a cohort of patients undergoing major spine surgery. This effect has also been shown to be present when using dexmedetomidine for sedation during procedures performed under spinal anesthesia. There is evidence that dexmedetomidine decreases postoperative pain, postoperative opioid usage, and nausea. Dexmedetomidine is also an adjunct infusion during general anesthesia. It is ideally suited for this indication for the reasons stated above. It is also used frequently for sedation during the performance of awake intubation. ![]() It is used for procedural sedation for a variety of operations. Äexmedetomidine is commonly used in anesthesia practice as well. Additionally, studies demonstrating the benefit in clinical outcomes related to improved sleep generated by dexmedetomidine are sparse. However, it is also important to note that there is data showing alteration of normal sleep patterns, and subjects achieve no restorative rapid-eye-movement or slow-wave sleep. This practice is supported by research showing dexmedetomidine often yields sleep quality closely related to stage 2 non-REM sleep. It has also become common to treat poor sleep in the ICU with dexmedetomidine infusions at doses as high as 1.5 mcg/kg per hr. The beneficial effects in this particular patient population extend into longer outcomes, including survival at two years and improved cognitive function and quality of life. This effect has been particularly useful in the treatment of elderly post-cardiac surgery patients. ![]() These reductions may be related to the ability of dexmedetomidine to reduce the need for other medications (for example, propofol, benzodiazepines, opioids) to promote a comfortable/cooperative patient. Evidence also exists that there is a reduction in both the time to extubation and the number of ventilator-dependent hours in patients with delirium. ICU sedation with dexmedetomidine has been demonstrated to decrease the incidence and duration of delirium and delay the onset of delirium compared with other sedatives. Given THAT inherent analgesic properties are rare with most sedatives, dexmedetomidine produces an opioid-sparing effect. Additionally, it does not require stoppage to accomplish extubation and is safe to use in non-intubated patients because it does not produce significant respiratory depression. This expanded list of indications is because it commonly produces a sedated state allowing patients to be comfortable and cooperative during mechanical ventilation. Over time, usage has expanded to off-label uses, including treatment and prevention of delirium, adjunctive analgesia, therapy for insomnia in the ICU, and treatment of alcohol withdrawal. The FDA-approved indications for dexmedetomidine are sedation of intubated and mechanically ventilated patients in the intensive care unit (ICU) and peri-procedural (or peri-operative) sedation of non-intubated patients. ![]()
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